ICU death rate higher in hospitals primarily serving minorities

Death rates have been declining for critically ill patients in intensive care units (ICUs), but a new U.S. study suggests gains have been limited at hospitals with large numbers of minority patients.

Data on almost 1.1 million ICU patients at more than 200 hospitals from 2006 to 2016 show a steady annual 2% decline in ICU death rates at hospitals with few minority patients, but not at hospitals where at least one-fourth of patients were Hispanic or African-American.

African-American patients also appeared to fare better at hospitals that served fewer minorities. Mortality rates for this group fell 3% each year at hospitals with few minority patients while remaining fairly constant at hospitals serving large numbers of minorities, researchers report in the American Journal of Respiratory and Critical Care Medicine.

“We do not know whether the worse outcomes observed in minority serving hospitals reflect caring for an increasing disadvantaged population or differences in hospital practice,” said lead author Dr. John Danziger of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.

“However, as we consider how to allocate limited health care funds, our study suggests that minority serving hospitals, and they patients they care for, are in great need of dedicated funding and programs to mitigate the disadvantages facing African Americans,” Danziger said by email. “This might include additional medical resources to better treat those diseases that preferentially affect African Americans, such as heart failure and kidney disease, as well as access to primary care and health literacy.” In addition to looking at the proportion of minority patients served at each hospital, researchers also identified “minority serving” hospitals, where the proportion of minority patients was twice as large as the proportion in the surrounding community.

Almost one-third of critically ill African-American patients and roughly half of critically ill Hispanic patients were treated at just 14 of the 200 hospitals included in the study.

Compared to hospitals serving few minority patients, hospitals serving more minorities tended to treat younger patients, but also sicker patients with more chronic complex health problems, the study found. Critically ill patients in their emergency rooms also had to wait longer to be transferred to the ICU.

The study only included hospitals that use the same platform for electronic health records. Another drawback is that researchers lacked data on certain patient characteristics that might influence outcomes such as insurance status, income, and lifestyle habits, researchers note in the American Journal of Respiratory and Critical Care Medicine.

The study also doesn’t offer insight into differences in hospital care that might explain the disparities, said Dr. Harlan Krumholz, director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation in New Haven, Connecticut.

“What is not clear is whether this is identifying quality differences or something more systemic that has its roots in the pre-hospital period,” Krumholz, who wasn’t involved in the study, said by email.

Part of the problem is that non-white patients may get worse care, or have more risk factors for a premature death, before they ever reach the hospital, said Daniel Lackland, a researcher at the Medical University of South Carolina in Charleston who wasn’t involved in the study.

This makes it critical for African-American and Hispanic patients to get regular primary care checkups and do what they can to address modifiable risk factors like smoking, eating habits, and exercise habits, Lackland advised. They should also know the signs of a heart attack or stroke and call 911 immediately when they suspect events like this, he advised.